ABSTRACT
Coronary size is one of the factors influencing the outcome of coronary interventions. This study was planned to screen main coronary arteries size in Egyptians in order to prove or disprove that Egyptians have small coronary arteries and to compare them to other races. 524 patients referred for coronary angiography were included in this study with no proximal local atheroma, spasm complete obstruction, stenosis nor multiple stenosis in the same vessel. Patients were divided into 3 age groups and were subjected to QCA for determination of the diameters of different segments of each coronary artery. The reference vessel diameter and cross sectional area were calculated for each, artery. In our study the influence of age, sex, hypertension [HTN] diabetes mellitus [DM], dyslipidemia and body surface area on coronary artery size were variable. The left main diameter was influenced by NTN, DM. and smoking; the left anterior descending diameter big age, HTN, and sex; the left circumflex diameter by age and RCA diameter by age and DM. Comparing our results to other races in different studies, we found the same range of Egyptian coronary artery size as other Caucasians, larger than Indo-Asians and comparable to the Americans. So, we concluded that Egyptians have large coronary arteries not small ones as we had expected
ABSTRACT
This study evaluated the immediate and short term effect of relief of mitral valve obstruction by balloon mitral valvuloplasty [BMV] on the right ventricular [RV] systolic and diastolic performance 13 males and 12 females, aged 15 to 39 years [means = 24] with significant mitral stenosis [MS] were studied by color echodoppler [CED] and equilibrium radionuclide angiography [ERNA] within a week before and 24-48 hours and 6 months after performance of BMV. The latter was done by the double balloon technique in 23 patients and by single balloon technique in 2 patients BMV resulted in a high significant immediate drop in the transmitral diastolic pressure gradient [MDPG] from 19.7 +/- 4.6 to 3.04 +/- 2.3 mmHg. Also, the systolic pulmonary artery pressure [SPAP] dropped significantly from 71.4 +/- 21.8 to 43.8 +/- 14.8 mmHg. Meanwhile, the mean PAP dropped significantly from 48.8 +/- 15.5 to 38.2 +/- 11.5 mmHg. By CED, BMV resulted in a highly significant increase in the mitral valve area [MVA] from 0.98 +/- 0.12 to 2.2 +/- 0.5 cm2. Meanwhile, the RV-systolic pressure [RVSP] dropped significantly from 66.7 +/- 21.6 to 41.0 +/- 15.5 mmHg, together with a significant decrease in the mean PAP from 43.9 +/- 10.1 to 29.4 +/- 12 mmHg. 2 patients had suboptimal results [mean MVA = 1.4 +/- 0.1 cm2]. However, their RVSP decreased significantly from 97.5 +/- 17.4 to 60 +/- 1.0 mmHg. ERNA study revealed a significant immediate improvement in the RV-systolic [RV-ejection fraction, RVEF] and diastolic [peak filling rate, PFR and time to peak filling rate, TPFR] performance RVEF increased significantly from 45.6 +/- 9.0 to 49.5 +/- 9.8%. PFR rose from 1.44 +/- 0.26 to 1.56 +/- 0.2 end diastolic volume [EDV] per second TPFR decreased significantly from 148.2 +/- 31.6 to 130.6 +/- 20.2 msec. RV-function improved significantly even in patients with suboptimal results. RVEF rose from 34.5 +/- 5.2 to 39 +/- 5.7%. PFR rose from 1.17 +/- 0.3 to 1.39 +/- 0.1 EDV/sec. TPFR decreased from 1 73.5 +/- 11.1 to 141 +/- 19.7 msec. On short term [6 months] follow up, BMV resulted in sustained or further improvement in the hemodynamic outcome in patients with immediate optimal results. The mean MVA was 2.09 +/- 0.53 cm2. The mean PAP [by CED] dropped significantly further to 18.5 +/- 3.4 mmHg. 3 patients developed mitral restenosis [MVA = 1.03 +/- 0.06 cm2 and RVSP = 100 +/- 10 mmHg]. This was reflected into depressed RV-function [RVEF was 327%, PFR = 1.20.42 EDV/sec., and TPFR = 181.7 +/- 9.1 msec]. In the remaining 22 patients who maintained a widened MVA, RVEF rose significantly to 56.8 +/- 5.3, PFR increased significantly to 1.7 +/- 0.17 EDV/sec. and TPFR decreased significantly to 127 +/- 0.3 msec. In conclusion, successful BMV results in immediate and maintained [6 months] improvement in the RV-systolic and diastolic function